title: First hour initiation of breastfeeding and exclusive breastfeeding at six weeks: prevalence and predictors in a tertiary care setting.
abstract: OBJECTIVE
  To assess the prevalence of first hour breastfeeding initiation and exclusive breastfeeding at 6 wk and identify its barriers in healthy term babies born in a tertiary hospital setting.
  
  
  METHODS
  A prospective observational cohort study was carried out in consecutively selected 400 mothers who delivered (normal, instrumental or cesarean) term healthy babies in a tertiary care hospital setting. All mother-infant dyads were enrolled within 48 h of delivery.
  
  
  RESULTS
  Breastfeeding was initiated within first hour in 255 out of 400, i.e., 64 % of babies. Cesarean delivery and male gender were strongest risk factors for delayed initiation of breastfeeding [OR (95 % CI) = 1.99 (1.14-3.48) and 34.17 (17.10-70.40) respectively]. Among the babies followed up till 6-8 wk, 83 % were exclusively breastfed. Breast milk substitutes were given in 172/400 (43 %) babies on day one, which emerged as an independent predictor of failure to continue exclusive breastfeeding at 6 wk (OR 2.96; 95 % CI 1.09-8.06). Odds of exclusive breastfeeding were two times higher in babies breastfed within first hour (n = 255/400, 64 %) when compared to babies initiated breastfeeds beyond first hour (n = 145/400, 36 %) (OR 2.01;05 % CI 1.12-3.61).
  
  
  CONCLUSIONS
  Cesarean section and male gender emerged as significant risk factors for delayed initiation (beyond first hour) of breastfeeding in the index study cohort. In addition, use of breast milk substitute emerged as the only predictor for failure to continue exclusive breastfeeding at six weeks in a tertiary care hospital.
authors.affiliation: Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors.forename: Vineetha
authors.initials: V
authors.lastname: Raghavan
authors.forename: Bhavneet
authors.initials: B
authors.lastname: Bharti
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.forename: Kanya
authors.initials: K
authors.lastname: Mukhopadhyay
authors.forename: Lakhbir
authors.initials: L
authors.lastname: Dhaliwal
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000379:methods*; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D006801:Humans; D041943:Infant Formula / Q000008:administration & dosage; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D011446:Prospective Studies; D012737:Sex Factors